Neurologic Complications in Adult ECMO

Treatment with extracorporeal membrane oxygenation (ECMO) has increased tremendously during the last decade due to high survival rates during the H1N1 2009 pandemic and positive technical development. ECMO is used in the veno-venous configuration (V-V ECMO) for pulmonary support in severe respiratory failure with preserved cardiac function or as veno-arterial ECMO (V-A ECMO) to bypass the heart and lungs during cardiac failure with or without pulmonary support. Neurological complications after critical illness occur frequently. Short-term mortality and long-term disabilities are high in patients with neurological complications. Some of these complications may be directly related to ECMO treatment (e.g., intracranial hemorrhage, stroke, and peripheral nerve lesions). This chapter presents a virtual case of a patient who presented with neurological sequelae after being treated with V-V and V-A ECMO for severe respiratory failure with circulatory complications. Diagnosis, treatment options, and possible prophylactic measures are developed through questions and answers regarding the case, followed by a discussion of the current available literature and clinical experiences. At the end of this chapter, nine review questions give the opportunity to test the learning outcome of this chapter.